Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk
Authors: Sofia Gonçalves Viamonte, Ana Vieira Joaquim, Alberto Jorge Alves, Eduardo Vilela, Andreia Capela, Cristina Ferreira, Barbara Fresco Duarte, Nuno Dias Rato, Madalena Pinheiro Teixeira, Aida Tavares, Mário Santos, Fernando Ribeiro
Journal: JAMA Cardiology (2023)

Importance Cardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance. Objective To assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk. Design, Setting, and Participants This prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention. Interventions Participants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week. Main Outcomes and Measures The powered primary efficacy measure was change in peak oxygen consumption (V̇ o 2 ) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy. Results A total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇ o 2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (−12.3 [11.8] mm Hg vs −1.9 [12.9] mm Hg; P &amp;amp;lt; .001), diastolic BP (−5.0 [5.7] mm Hg vs −0.5 [7.0] mm Hg; P = .003), and BMI (−1.2 [0.9] vs 0.2 [0.7]; P &amp;amp;lt; .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P &amp;amp;lt; .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P &amp;amp;lt; .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P &amp;amp;lt; .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P &amp;amp;lt; .001). Conclusion and Relevance The CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇ o 2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy. Trial Registration ClinicalTrials.gov Identifier: NCT05132998